Intraoperative endoscopy for laparoscopic Roux-en-Y gastric bypass: leak test and beyond.

INTRODUCTION: The aim of this study is to determine the role of intraoperative endoscopy in identifying gastrojejunostomy leak in laparoscopic Roux-en-Y gastric bypass (LRNYGB) and to define other roles that can be achieved by this diagnostic maneuver.
METHODS: A retrospective chart review of all patients who underwent LRNYGB at both Cleveland Clinic (USA) and Adan Hospital (Kuwait) was undertaken. All operations were performed by 2 surgeons (B.C. and F.A.).We analyzed the following parameters in the patients: mean age, estimated blood loss, average hospital stay, the number of patients who had intraoperative leaks, and those who developed intraoperative pouch bleeding.
RESULTS: Between July 2004 and January 2009, 290 patients (244 women-85% and 46 men-15%) were operated upon with a mean age of 42 years (range: 19 to 61 y). The average body mass index was 48 kg/m2 (range: 35 to 65 kg/m2), and the average American Society of Anesthesiology classification of 3 (range: 2 to 4). Mean estimated blood loss of 95 mL (range: 27 to 310 mL) and the mean operative time was 165 minutes (range: 102 to 348 min). The average hospital stay was 3 days (range: 2 to 13 d). Eleven patients (3.7%) developed intraoperative leaks that were controlled intraoperatively. Ten patients (3.4%) developed intraoperative pouch bleeding, in 6 of them the bleeding vessel was controlled laparascopically. No documented postoperative leak in this series of patients. One patient (0.34%) underwent diagnostic laparoscopy for clinical suspicion of a leak which could not be identified.
CONCLUSIONS: Intraoperative endoscopy for LRNYGBP may reduce the leak rate postoperatively and also, may minimize postoperative endoscopy and surgical intervention for gastrointestinal bleeding.